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Hospital parking: health care’s controversial cost

Shalimar Novak is sick of paying for parking. The social worker has been to Toronto’s Mount Sinai once or twice a week recently for appointments related to her pregnancy, and paid about $15 every time. “It definitely adds up,” she says. “And when you have a kid coming, you’re thinking in diaper dollars. It would be nice if that money could go towards things you need, instead of going towards parking.”

She and her husband have decided they’ll probably take a taxi to the hospital when she goes into labour, rather than dealing with the hassle and cost of days of parking.

Mount Sinai doesn’t have its own parking. Patients and staff park at nearby lots run by private companies or by the city. But the costs in hospital-run lots aren’t much different.

At the nearby Hospital for Sick Children, visitors pay up to $20 a day, and parents can buy monthly passes for $200. That cost of up to $2,400 a year – or more, if two parents need to park – is a strain on families, says Susan Kuczynski, parent liaison for Ontario Parents Advocating for Children with Cancer. She’d like to see more accommodation for parents. “I understand the visitor having to pay the rate – that’s a choice. As a parent, you don’t have a choice,” she says.

The issue is large enough that the Ontario government recently promised to cap or cut hospital parking fees. But at the same time, cash-strapped hospitals have grown dependent on the revenue parking provides. And it’s not just a question of fees: some hospitals struggle to make sure their lots have space for patient and visitor parking by doing things like shuttling staff in from off-site parking locations. Still others offer patient-centred services, like valet parking. So what’s working – and what’s not – in hospital parking lots?

The high cost of hospital parking

Hospital parking fees for patients range from free at some rural locations to more than $20 a day in downtown Toronto. Hamilton Health Sciences and Hamilton’s St. Joseph’s Healthcare recently announced a 25% rate hike to $25. And tickets for infractions at metered lots can run $30 or even $80.

These rising hospital parking fees inspired an Ontario Liberal election campaign pledge around parking costs, which Health Minister Eric Hoskins promised to follow through with in July. The platform included a promise to “work with hospitals to cap or cut parking fees for those who must visit the hospital frequently, either due to a medical condition or to regularly visit a loved one.”

The Ministry of Health and Long-Term Care didn’t answer questions about the specifics of the program. Samantha Grant, spokesperson for the ministry, did offer this statement on the plan: “Our government is going to bring in a realistic plan to help Ontarians with their living costs today as it pertains to hospital parking fees. This is a priority for our government and the Minister has been actively involved in engaging the ministry to come up with a reasonable plan and recommendations on the best way forward.” In January, the federal government also announced there would no longer be GST/HST on hospital parking, though it’s not clear if those savings will be passed on to patients.

A Canadian Medical Association Journal editorial addressed parking fees in 2011. “Parking fees amount to a user fee in disguise and flout the health policy objective of the Canada Health Act. … This is parking-centred health care, which is not compatible with patient-centred health care,” wrote interim editor-in-chief Rajendra Kale.

He also cited Scotland, which got rid of most hospital parking fees in 2008. The government saw it as a matter of principle, arguing that hospital parking fees went against the idea of free health care, as well as being a source of stress for patients.

That’s the issue for Canada as well, says Stephen Duckett, ex-Alberta Health Services president who now works at Australia’s Grattan Institute. He believes hospitals should aim to break even on parking costs, but that they’re not a user fee. “It comes down to the question, do you think parking to get to a hospital appointment is a health service?” he says. “I’m inclined to say it’s not. If people think parking is a health service, what about the gas to get to the parking? Is that a health service as well?”

Vicki McKenna, vice-president of the Ontario Nurses’ Association, argues it is essentially a user fee. Parking costs make people think twice about visiting patients, she says, and she’s heard of patients scheduling appointments for when their pension cheques comes in. “Some people will ration their health care, really, [because of parking fees],” she says. “It’s unmanageable for many people, particularly those on fixed incomes. And even for those that aren’t, they struggle to pay it.”

Some hospitals, including SickKids, have discretionary funds that help people with very limited means with expenses like parking, public transit or meals.

In Ontario, the funds that come from parking have become more dear as hospitals have faced 0% base operating funding increases from the government. “Hospitals do their best to provide parking solutions that not only work well for patients and visitors, but also for the organization’s operational needs,” the The Ontario Hospital Association said in a statement.

Northumberland Hills Hospital in Cobourg nets about $500,000 a year from parking. “For a hospital our size, that’s the equivalent of a program,” says Jennifer Gillard, communications director. But charging for parking can also be more challenging in small communities, since people are used to parking elsewhere for free.

The Ottawa Hospital, in contrast, brought in $17.3 million from parking in 2013/14, which gave them a surplus of $12.6 million after the lot’s $4.7 million of expenses. That surplus, which is 1.2% of their total operating budget of $1.05 billion, goes towards medical equipment. “It’s a little bit of a selling feature; it helps ease the pain,” says Richard Wilson, the hospital’s CFO. He points out that the government doesn’t help fund parking lots, and that hospital budgets are tight. “As a CFO of course I enjoy the money, and we need it to provide the care that we do. Having said that, I wish we could provide free parking, because patients see it as a user fee, disguised,” he says.

Some Ontario hospitals run their lots themselves, while others outsource the task to private firms. After costs, the revenue from hospital parking is always reinvested in patient care, according to the Ontario Hospital Association.

In Alberta, parking rates are also rising. Alberta Health Services began a three-year plan to raise rates last year, which will eventually bring in an extra $7 million annually across the province. In 2013/14, hospitals across Alberta garnered over $71 million from parking. (Charges are set based on a market-rate analysis.) Funds are not funneled to patient care; rather, they’re used to cover the parking facilities’ operating costs, maintenance and upgrades, as well as construction of new lots. Any excess goes towards a reserve fund for repairing lots and building new ones. And unlike in Ontario, private companies are not involved, beyond services, like snow removal, that are contracted out.

Finding spots & patient-centred parking

Many hospitals are also trying to manage lots that are often full. Sudbury recently voted to approve Health Sciences North buying land for nearly 1,000 more parking spots. The hospital currently shuttles some employees from off-site locations in an attempt to avoid full lots. The Ottawa Hospital does the same, renting lots from other locations across the city. Employees are even on waiting lists for parking. “We get more complaints [from patients] about access to parking than about cost,” says Wilson.

Others are focusing on the patient experience. Sunnybrook has a valet service, where for an extra $3, patients can leave their car at the door from 9 a.m.-5 p.m. on weekdays. The service, which is free for elderly customers or those with a disability permit, started in 2006. It’s now used by about 30-40 people a day, with busy days getting up to 100. It was created in response to a parking shortage, but has been carried forward because of its popularity.

The Ottawa Hospital recently introduced a similar program, where “blue-tie ambassadors” help patients out of their cars at the door, leaving drivers free to find parking. It was inspired by a patient complaint.

Cathleen Bryden wrote to the hospital’s CEO, Jack Kitts, after a demoralizing experience with a malfunctioning parking pass and an unhelpful security guard. She had to leave her husband, nauseous from treatments for advanced bone cancer, by a parking machine as she ran across campus to get a new pass from an office in another building.

That became part of a broader discussion about hospital parking that included the hospital shadowing Bryden and her husband one day, which highlighted another issue. Caregivers like Bryden were driving up to the building, parking illegally, finding a wheelchair, loading their loved ones into it, finding a spot for them inside the doors and leaving them there while they parked – a stressful start to appointments. The hospital now has the ambassadors at three of its campuses, as well as the cancer centre. “It’s key because you’re already often in a rush,” says Bryden. “And it’s very hard psychologically to take those first steps every day … my husband had to brace himself every time.”

Having a friendly greeting and some help can make a big difference, says Bryden. After all, “this is the first experience patients have with the hospital.”

Enter the debate: reply to an existing comment

33 comments

nancyAugust 14th, 2014 at 11:11 am

not a lot offered on supply and demand (and rates) for employee parking. ? could charge more to employees to offset patient/visitor rates and encourage employees to use other modes of transportation (i.e. park and walk, bicycle, public transportation). ? is there an obligation for the org. to provide parking to employees? Maybe… offer organizational incentives for employees to choose these alternatives to driving to the door.

I worked for a hospital foundation back in the 90’s. They had a two-tiered staff parking payment system: managers and upper level administrators received their parking for free (presumably a ‘job perk’) while regular hourly waged staff had to pay a monthly fee that capped the number of times you could enter/exit the parking lot each month (then pay extra if you exceeded that cap).
For some reason, exempting those whose salaries were more than double mine didn’t need to pay.
And there was absolutely no thought given to the staff/patient/visitor ratio of spaces–whoever got there first got a space. Too bad if you needed to visit the hospital midday.
One of the many inequities related to hospital parking.

The administrators have the best parking lots at my hospital, at no cost to them. Then the doctors, who pay. Then the patients, who pay.

You can see where health care is going based on this simple observation.

I say we fire half of the admins in each hospital in Canada. They are like a parasite in that they proliferate and suck the money and time out of everything while providing no true value. The ones who are left can pay the most for parking. Doctors can pay as well.

It’s an unfortunate situation, but are you truly advocating that a person pay a fee to work where they work? Increasing fees for employees is a terrible idea. It would breed resentment towards their employer AND towards the patients. If there is a payment to be made, it should be the same across the board by all persons. Employees will no doubt always end up paying more than a regular visitor – after all, they work there.

Employees generally attend work for a full 8 to 12 hour day. They can take public transportation of pay a fee but parking for financially-strapped victims of health emergencies or those with ill-health attending out-patient appointments should not have to be further financially challenged by sky-high parking rates. The sick and their support people should have priority access at the lowest rates or better yet free access to parking. Doctors and administrators with six (or seven) figure salaries can afford to pay top rates but in reality, hospital employees should take transit to work and leave the parking to those who need it. Hospitals can also keep a special access-controlled lot for employees who must use a car to do their job (e.g traveling nurses etc.)

As a student in the hospital I work with no pay, infact I pay over 6000 in tuition to work there. I have to pay for parking, Around 70$ a month. If you are visiting a family member why don’t you take the bus, as a person who lives in an area with -20 weather walking is not an option and even if it was many hospitals are located along highways, many health care workers do not have regular 9-5 hours, and would you wanna walk along the highway home after a 12 hour shift at night when you’ve been on your feet all day, would you want your family members doing that? I looked into the bus to avoid the high fees as the staff fee is still very high but a bus pass is 70$ a month and since I’m paying for insurance I might as well use my car. I do not believe that health care workers should be persecuted and have to fund visitor parking.

As a patient receiving chemo and post chemo treatment for two years it has been almost impossible with the parking. Now they have split the treatment day in two for their convenience and efficiency so we now go one morning for blood work and doctor visit and the next for treatment making two days parking expenses. It is mind boggling to me as a retired nurse how this is more efficient because you have to register on both days instead of just one and get wrist bands both days. %featured%The parking should be free to all, patients and visitors. We never had these problems 50 years ago nor did the hospital have to go out begging for money. What on earth has changed?%featured%

Kate – it’s great that you shared this perspective. I worked at a cancer treatment centre before and after they implemented the 2-day approach and truly it is a lot more efficient. There are many things that have to happen between the doctor visit and the treatment (check labs, check doses, enter everything in the computer, mix the chemo) and patients would end up waiting around for 3 hours in the middle of the day. This usually meant purchasing their lunch if they were from out of town. And it was a challenge for us not to have treatment beds sitting empty in the morning (as most patients were still seeing their doctors) and then to get all the treatments done before the day was over. Absolutely it’s more efficient for the centre, but this parking issue is all too real for the patients. I feel for you.

Staff can probably afford to pay; visitors maybe,…… but patients with appts and immediate family onf in-patients – should never have to pay.
Has anyone considered asking for donations instead? I suspect lots of visitors – those who can afford to- would donate a generous parking fee when visiting family &friends.

Why can staff “afford to pay” and patients can’t? Patients are ordinary people in society, just like hospital staff (some may even be healthcare workers or hospital staff). Ultimately nobody should have to pay, however forcing someone to pay to work where they work is a redundancy that breeds resentment amongst the staff.

Develop a system whereby visitors/staff can park for free based on their employment or whom they are visiting/having an appointment will, and implement strict enforcement controls to ensure people aren’t just trying to bum a free spot while they get a sandwich across the street/

Hospital parking needs to be free for patients and costs covered as part of medical care. What happens to those who cannot pay?
Patients should not be caused extra stress by worrying about parking fines as usually they do not know how long they will need to be there anyway!
Stress has a negative effect on healing, thus increasing costs for the entire health care system.

None of the above. Parking at hospitals on land that is owned by the taxpayers of Ontario should be free to all citizens of Ontario. When you have the stress of needing to go to a hospital…whether it’s for treatment or to visit a friend or loved one and help them through their illness, you should not be penalized with the stress and financial strain of a parking fee. Tommy Douglas’ vision was government provided health care for all Canadians regardless of their financial status. Today, many people can not visit a hospital or keep an appointment because they can not afford the $25.00. Disguise it as you will, but this is a user fee usurped from people who need health services and it’s unacceptable.

Oddly enough, the question not being addressed is which private companies administer these lots and how much money are they making? The revenue lost to the hospital must be made up by both the Provincial and Federal governments. That’s what we elect and pay them to do. Provide health care to all citizens regardless of their ability to pay. Let’s get rid of this terrible tax on the sick and needy in our society.

IT’S A USER FEE! Paid by the sick and those who care for them. It’s an egregious user fee because the cost is ridiculously high and what do you get as a user?… a parking space. Not care for your health or your loved one’s health but a piece of asphalt. In some ways I’d rather someone say your appointment cost this clinic $500 today but we are only going to charge you $20. I’d think what a deal. Of course then as a paying customer of the health care offered at my appointment I would have more questions about things being necessary and how much they cost. But that is not our system. If hospitals are giving us the line that parking pays ultimately for our healthcare “Hospitals do their best to provide parking solutions that not only work well for patients and visitors, but also for the organization’s operational needs,” The Ontario Hospital Association said in a statement” we as citizens can demand more from our hospitals. I urge all of you who have paid for parking at hospitals to consider this a fee for your healthcare and act accordingly as a customer.

As a Medical Equipment Sales rep, I spend a lot of money every year to park in hospital parking and I have also been frustrated with this expense increasing constantly. Another thing that changed is that many of these parking lots are now contracted out to third party companies to manage and profit from. At one time the profits from parking went to the purchase of capital equipment, it is now going to parking lot contract companies. I only wish the profits could return to support hospital programs and equipment and I would feel that the expense was going to a good cause…..

Follow rhe money all hospitals outsource the parking to a 3rd party. Question is how much are they paying for this service? . My guess is that they are making a huge profit and likely some oversight is required . In other words only a portion of the fes actually goes to the hospital and if some oversight is provided perhapa the costs would be quite a bit less.

There should be no reason to charge patients the astronomical parking fees at hospitals or health clinics! It’s a cash cow…total greed at the expense of the sick!!! What a “sick” society to allow this to continue!

I don’t know about other cities, but in Winnipeg, people — apparently healthy and well-off enough to afford such entertainment — can park all day and night at government gaming casinos FOR FREE. There is even valet service offered for a most nominal fee. Why not charge for parking at casinos and use that revenue to pay for whatever (often dubious) services hospital parking pays for instead of extorting the sick, dying, and most vulnerable among us?

I work at the new “Royal Victoria Regional Health Centre and I too find the amount they charge patients is ridiculous but I also find the amount that we as employees pay each year in parking is just as ridiculous. We pay the hospital to come to work and although so many are afraid to say anything due to the risk of losing their jobs. I haven’t yet to understand how our parking rates are so high at appx average of 50.00 a month? And patients are paying even more? Where does all this money go?

Patients are already stressed, and often unable to pay high costs of parking-, medications, etc..–therefore, they are forced to limit their visits to others, or their own appointments for medical care. It being a tax deduction does very little for those who struggle on a monthly pension or fixed income., when they have to come up with daily costs.!!. I personally was hospitalized for 5 1/2 months and my family not only paid for regular parking, but came from out of town. I also have had cancer twice, and spent hundreds on parking..often being very strapped for daily costs. Why is there free parking at casinos- ridiculous!!!

To all those suggesting that employees pay more to park at the hospital, do you pay to park where you work?? It is ridiculous that hospital employees, patients for anyone have to pay to park at a hospital. I think if hospital employees have this expense, then maybe the Ministry of Transportation, Ontario Hydro and all kinds of other places where employees park for free should also be charged! Maybe then patients could be opted out and use these additional fees to cover parking at hospitals.

I agree with what they did in Scotland in 2008. It is a matter of principal. I’m disgusted with those entities (landlords) that contruct buildings that rent space to professionals providing medical or treatment facilities, and that once constructed, feel as though they are great business people because they make profits from easy money on the public who are forced to park there because it’s not practical to park anywhere else. It’s so petty. The businesses renting there should pay for all of the costs of running the business including parking. Not the customer. It’s not a public parking facility for others to use.

I’m thankful I don’t drive. I see so many people paying to park at alarming rates just to enter the hospital parking lots. I had a friend take me and had to come up with the money to pay as my daughter was in, that meant that I had to figure out how long I’d be there to visit. I wanted to be there most of the day but sadly had to tell her I could only stay for 2 hours or get a fine, I would have gladly taken the fine just to be with her but knew I’d never been able to afford to pay it and that was a jail term if I didn’t pay. It breaks my heart to know there are families that can’t see their loved ones due to financial reasons, they want to be there but can’t afford to see them. Hospitals are an asset and the government is taking advantage of this. There has to be a better way to control the flow of traffic in and out of hospitals besides paying heavy fees. In some hospitals an appointment is given and you arrive thinking an hour or two so you pay that just to get to your appointment and between wait time and actually seeing the doctor/s you’ve now taken up to 4 hours and come out to a fine in some cases and in other cases told to pay the extra time spent and not having cash on you to pay or not having the extra at all if you happen to be a low-income patient. Patients are avoiding hospitals due to the costs and putting their own health at risk because of it and all because they can’t afford to park their car, not everyone lives near a hospital, it would be nice if we could all just walk to the hospital but we can’t so we are forced to choose between dipping into the grocery fund or skipping the appointment for a later time which rarely comes as those rarely have the extra to spend. My town was one of the last ones that got the pay to park, parking lots and today most will park in the doctor or nurses part as most of knowing each other so we know if they are working or not, just to avoid paying and make life a bit easier. Something has to be done about this. Gone are the days when kindness and empathy were paramount and in with the days where no one seems to care anymore. Sad world we live in.

Visiting a hospital is not a fun social event like a casino, where it is government run and free! So many patients require necessary tests which take time and others are visiting sick loved ones but the onerous pay-for-visit fees are prohibitive. What’s wrong with our government that we can pay for criminals for their incarceration but cannot ease the load on patients who have had to wait an interminable amount of time and then penalize them with huge fees for family members to visit?

Funny that with all the millions raised by Cancer walk-a-thons etc. that there is so little attention given to provide parking access to the patients and family who have to absorb huge parking costs in order to receive treatment and support their family/fiends by visiting. Cudos to Sick Kids and Sunnybrook for at least trying to do better.
I see a huge opportunity for The Salvation Army and other highly practical charity organizations to step in here to organize and administrate such tangible acts of mercy for the sick and dying. As a recently diagnosed terminal cancer patient I would be glad to provide whatever time I have left to help fund raise for this worthy endeavor.
At the very least least the city should allow street parking within 2 blocks of any hospital. This issue has become a a source of bureaucratic shame for Ontario.

This document is provided under the terms of a CreativeCommons Attribution Non-commercial Share Alike license. The terms of the license are available at: http://creativecommons.org/licenses/by-nc-sa/3.0/. Attributions are to be made to HealthyDebate.ca, a project under the direction of Dr. Andreas Laupacis, at the Keenan Research Centre, Li Ka Shing Knowledge Institute of St. Michael’s Hospital.